Making Sense of Fibromyalgia

Daniel Wallace, MD & Janice Brock Wallace

Between 1930 and 1980, it was known that some patients recovering from infectious diseases such as polio, mono and brucellosis had a prolonged convalescence and persistent systemic symptoms. By the early 80s a herpesvirus known as Epstein-Barr virus joined the group. For unknown reasons, it tneded to afllict upwardly mobile young people. Epstein-Barr virus antibodies could easily be tested for and its post viral fatigue complaints were treated symptomatically and waited out.

However, the E-B syndrome epidemic turned out not to happen. The National Institutes of Health, United States Centers for Disease Control and Prevention, and other centers showed that over half of the US population has evidence of exposure to E-B virus in their blood and standard antiviral therapy for herpes was not beneficial in these patients. Chronic Epstein-Barr virus fatigue syndrome did not exist, but it was over diagnosed and in fact is extremely rare.

In 1984 it was suggested that fatigue syndromes and fibromyalgia could be one and the same. The CDC devised a validated criterial in 1988 and again updated in 1994 for Chronic Fatigue syndrome.

Revised CDC Criteria for CFW 1994

1. Chronic fatigue unknown cause that persists or returns for more than 6 months, resulting in a substantial rduction in occupational, educational, social and personal activities.

2. the presence of 4 or more of the following symptoms concurrently for more than 6 months:

* sore throat

* tender cervical or axillary lymph glands

* muscle pain

* multijoint pain

* new headaches

* unrefreshing sleep

* postexertion malaise

* cognitive dsyfunction

Comparative surveys show that 26-70% of fibromyalgia patients have CFS, and 35-70% of those with CFS have fibromyalgia. Forty-79% also have lupus. CFS patiens, have greater elevations of antiviral antibodies than is observed in fibromyalgia patients. Whereas only a minority of fibromyalgia patients complain of sore thorat, show evidene of swollen glands or fevers and have onset after a flu-like ilnnes, these features are found in most CFS patients.

Comparisons of FMS and CFS

Female sex FMS 90% CFS 80%

Muscle aches FMS 99% CFS 80%

Joint aches FMS 99% CFS 75%

Fatigue FMS 90% CFS 99%

Poor sleep FMS 80% CFS 50%

Fevers FMS 28% CFS 75%

swollen glands FMS 33% CFS 80%

postexertional fatigue FMS 80% CFS 80%

Sudden/acute onset FMS 55% CFS 70%

Headaches FMS 60% CFS 85%

Cognitive dysfunction FMS 20% CFS 65%

I think this chart shows how the two overlap better than anything else I've seen. I'm sure those of you with FMS were surprised to see that only 20% show a cognitive dysfunction problem. And even though 99% of CFS patients show extreme fatigue, only 50% actually are having poor sleep. Both CFS and FMS, like so many autoantibody type illnesses, have so many variables that it is extremely difficult to draw the lines separating them. This is another one of those cases where the similarities are more prominent than the differences.

"Physicians think they do a lot for a patient when they give this disease a name." Immanuel Kant (1724-1894)